Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study
Abstract Background Near-infrared spectroscopy (NIRS) enables a non-invasive measurement of tissue oxygen saturation (StO2) in regions illuminated by near-infrared lights. Vascular occlusion test (VOT) serves as a model to artificially induce forearm ischemia-reperfusion. The combination of StO2 mon...
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| Language: | English |
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BMC
2025-01-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-03312-7 |
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| author | Ling Peng Yeying Zheng Fei Guo Mengdan Su Wei Wei |
| author_facet | Ling Peng Yeying Zheng Fei Guo Mengdan Su Wei Wei |
| author_sort | Ling Peng |
| collection | DOAJ |
| description | Abstract Background Near-infrared spectroscopy (NIRS) enables a non-invasive measurement of tissue oxygen saturation (StO2) in regions illuminated by near-infrared lights. Vascular occlusion test (VOT) serves as a model to artificially induce forearm ischemia-reperfusion. The combination of StO2 monitoring and VOT allows for dynamic evaluation of the balance between oxygen delivery and consumption in tissue, as well as the functional reserve of microcirculation. However, the implications of these measurements for patient outcomes remain inadequately understood. This study aimed to investigate the association between StO2-VOT measurements and the occurrence of postoperative acute kidney injury (AKI), in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods Between March 2020 and March 2021, 100 adult patients who scheduled to undergo cardiac surgery with mild hypothermic CPB were enrolled to this prospective observational study. StO2 was continuously monitored at the right forearm and ipsilateral VOT procedure was performed before initiation of CPB, at the time before weaning from CPB, and at the end of surgery. Preoperative and intraoperative factors, along with StO2-VOT parameters, were evaluated for their independent association with the occurrence of AKI following cardiac surgery. StO2-VOT parameters were also compared between patients with hyperlactatemia (peak blood lactate ≥ 4 mmol/L) and those without hyperlactatemia. Results In our patient population (n = 87), 13.79% (12/87) patients developed AKI after surgery. Multivariable analysis revealed that CPB time and post-CPB desaturation speed (D-speed) were independently associated with AKI. Post-CPB D-speed had an area under receiver operating characteristic (ROC) curve of 0.79 (95% CI, 0.66–0.93) with a cutoff value of 0.08%·min− 1 in predicting AKI. Patients with hyperlactatemia had longer pre-CPB T1 and higher D-speed during CPB. However, ROC analysis indicated that T1 and D-speed exhibited limited predictive capacity for hyperlactatemia. Patients with AKI exhibited an increased risk of prolonged ICU stays, postoperative stroke, reoperation, and in-hospital mortality. Conclusions NIRS monitoring combined with VOT shows promise in predicting postoperative AKI in patients undergoing cardiac surgery with mild hypothermic CPB. Trial registration ChiCTR1900021436 with registered date 21/02/2019. |
| format | Article |
| id | doaj-art-30932597b73c49a1b2379b54c690eee9 |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-30932597b73c49a1b2379b54c690eee92025-01-12T12:39:06ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-0120111110.1186/s13019-024-03312-7Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational studyLing Peng0Yeying Zheng1Fei Guo2Mengdan Su3Wei Wei4Department of Anesthesiology, West China Hospital, Sichuan UniversityDepartment of Anesthesiology, Zigong Fourth People’s HospitalDepartment of Anesthesiology, Zigong Fourth People’s HospitalDepartment of Anesthesiology, West China Hospital, Sichuan UniversityDepartment of Anesthesiology, West China Hospital, Sichuan UniversityAbstract Background Near-infrared spectroscopy (NIRS) enables a non-invasive measurement of tissue oxygen saturation (StO2) in regions illuminated by near-infrared lights. Vascular occlusion test (VOT) serves as a model to artificially induce forearm ischemia-reperfusion. The combination of StO2 monitoring and VOT allows for dynamic evaluation of the balance between oxygen delivery and consumption in tissue, as well as the functional reserve of microcirculation. However, the implications of these measurements for patient outcomes remain inadequately understood. This study aimed to investigate the association between StO2-VOT measurements and the occurrence of postoperative acute kidney injury (AKI), in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods Between March 2020 and March 2021, 100 adult patients who scheduled to undergo cardiac surgery with mild hypothermic CPB were enrolled to this prospective observational study. StO2 was continuously monitored at the right forearm and ipsilateral VOT procedure was performed before initiation of CPB, at the time before weaning from CPB, and at the end of surgery. Preoperative and intraoperative factors, along with StO2-VOT parameters, were evaluated for their independent association with the occurrence of AKI following cardiac surgery. StO2-VOT parameters were also compared between patients with hyperlactatemia (peak blood lactate ≥ 4 mmol/L) and those without hyperlactatemia. Results In our patient population (n = 87), 13.79% (12/87) patients developed AKI after surgery. Multivariable analysis revealed that CPB time and post-CPB desaturation speed (D-speed) were independently associated with AKI. Post-CPB D-speed had an area under receiver operating characteristic (ROC) curve of 0.79 (95% CI, 0.66–0.93) with a cutoff value of 0.08%·min− 1 in predicting AKI. Patients with hyperlactatemia had longer pre-CPB T1 and higher D-speed during CPB. However, ROC analysis indicated that T1 and D-speed exhibited limited predictive capacity for hyperlactatemia. Patients with AKI exhibited an increased risk of prolonged ICU stays, postoperative stroke, reoperation, and in-hospital mortality. Conclusions NIRS monitoring combined with VOT shows promise in predicting postoperative AKI in patients undergoing cardiac surgery with mild hypothermic CPB. Trial registration ChiCTR1900021436 with registered date 21/02/2019.https://doi.org/10.1186/s13019-024-03312-7Near-infrared spectroscopyVascular occlusion testAcute kidney injuryHyperlactatemiaCardiopulmonary bypass |
| spellingShingle | Ling Peng Yeying Zheng Fei Guo Mengdan Su Wei Wei Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study Journal of Cardiothoracic Surgery Near-infrared spectroscopy Vascular occlusion test Acute kidney injury Hyperlactatemia Cardiopulmonary bypass |
| title | Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study |
| title_full | Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study |
| title_fullStr | Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study |
| title_full_unstemmed | Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study |
| title_short | Near-infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery: a prospective observational study |
| title_sort | near infrared spectroscopy combined with vascular occlusion test to predict acute kidney injury in patients undergoing cardiac surgery a prospective observational study |
| topic | Near-infrared spectroscopy Vascular occlusion test Acute kidney injury Hyperlactatemia Cardiopulmonary bypass |
| url | https://doi.org/10.1186/s13019-024-03312-7 |
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